Long-Term Survival and Operative Outcomes of the Bentall Procedure for Aortic Root Aneurysm, Aortic Dissection, and Endocarditis.

Abstract

Objective: To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection and endocarditis.

Methods: We identified consecutive patients undergoing Bentall from 1997-2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared.

Results: Of 1493 patients, 1378(92.3%) had surgery for aneurysms, 75(5%) dissections and 40(2.7%) endocarditis. The aneurysm group was older (61[50,70] vs 57[47,66.5] vs 56[49,64]; p=0.024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; p=0.026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; p<0.001), renal dysfunction (8.3% vs 22.7% vs 45%; p<0.001), shock (0.1% vs 10.7% vs 15%; p<0.001) and ruptures (0.4% vs 10.7% vs 10%; p<0.001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; p<0.001) and operative mortality (0.4% vs 1.3% vs 7.5%; p=0.001) were higher for endocarditis. Re-exploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; p=0.004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; p=0.94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (HR 1.04 (1.03, 1.05); p<0.001), chronic obstructive pulmonary disease (HR 2.12 (1.44, 3.11); p<0.001), renal dysfunction (HR 1.97 (1.4, 2.78); p<0.001) and ejection fraction (HR 0.97 (0.95, 0.98); p<0.001) were associated with late mortality but primary diagnosis was not.

Conclusions: The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.